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2025-08-07 LabMCoP Meeting Notes

2025-08-07 LabMCoP Meeting Notes

Date

Aug 7, 2025

Attendees

Present

Name

Organization

Present

Name

Organization

X

Nancy Cornish

CDC

regrets

Manjula Gama-Ralalage

CDC

X

Riki Merrick

APHL

X

Christina Gallegos

APHL

regrets

Amy Liu

Inductive Health / APHL

regrets

Raj Dash

Duke / CAP

regrets

John Snyder

 

X

Andrea Pitkus

UW

X

Kathy Walsh

Labcorp

regrets

Rob Hausam

Hausam Consulting

 

Pam Banning

 3M

X

Jake Bunn

CDC (Acting CLIA Core team)

X

Joseph Michael Bryan

CDC (DLS Statistician)

X

Kathryn Haass

CDC (NHSN - DHQP)

X

Kristi Betz

CDC (NHSN - Digital Quality Measures)

X

Diego Arambula

CDC (Datascience team)

X

Beth Tolar

CDC (Datascience team)

Discussion topics

Upcoming OOO

 

 

Premier healthcare database to evaluate blood cultures

Nancy

Looking for medical codes for blood culture in DB

table includes CPT codes

table with LOINC and SNOMED

87040 CPT code (Blood culture) - used for billing

Looking for help with creating an algorithm

not all tests in a lab workflow are LOINC encoding, so where labs dont have that functionality you will not have LOINCs

if CPT has a date, then look for the specimen collection date (+/- 10 days or so?) and if it’s close, then look for that

Do you have encounter information?

ICD-10 codes for bacteremia (identified bactremia) and sepsis (suspected, but may not be verified)

CPT codes can also be added when Sensitivity testing is added (or any other additonal tests that are being performed)

Could potentially also rule outut when specimen is acelluar blood

Use CPT and date, look for specimen collection date (being +/- 10 days of the CPT date), then fr the patient find all LAB_TEST_CODE and then evaluate observation text for each; if no LOINC used, then can exclude where specimen source is acellular blood, cord blood, specimen, urine, body fluids, can exclude, if Isolate, then these were done on a culture could use thse

LOINC component can be organism specific, then observation text would give you presence or absence finding words, if the LOINC component is generic like Bacteria

If LOINC has Bld.pos.growth as sytem, all of those would be follow up on a Blood culture

 

Specimen CMT terms submitted to SNOMED International

Christina

 

 

CSTE presentation

 

 

 

Lab tests as procedures or orderables

 

Definition from SNOMED for these hierarchies:

  • Observable entity: Information about a quality/property to be observed and how it will be observed

  • Evaluation procedure: No definition, other than it uses attributes that are similar to those used in the Observable entity hierarchy.  Our policy is to not add any new evaluation procedures that would logically be in the Observable entity hierarchy.

  • Technique is a separate hierarchy used to model observable entities: A technique (also called method) is a particular way of performing an activity or task.

Colonoscopy example:

Reference links:

clinical guidelines: Official journal of the American College of Gastroenterology | ACG

Quality Indicators: Official journal of the American College of Gastroenterology | ACG

Discussion:

  • Ask Jim Case what the difference is between these 3:

  • Is the colonoscopy report a single report or maybe 1 procedure report (the what, with what, how long it was done - would be captured in Procedure - FHIR v5.0.0 ) and 1 diagnostic report (what was seen - verbal and images - would be captured in DiagnosticReport - FHIR v5.0.0 )?

    • Both the procedure and the AP request would be represented by ServiceRequest - FHIR v5.0.0 - discussed where to use LOINC, which is ServiceRequest.code - looking at US Core value set: US Core Procedure Codes - US Core Implementation Guide v9.0.0-ballot

      • this could use some more guidance on when to use which of the referenced code systems - would like to understand when ICD would be used, and also would need guidance when to use CPT; SNOMED CT procedure codes vs LOINC should also be described

  • For CAP cancer reporting is using SNOMED CT - would be good to look which they chose to represent the performed lab test

  • Looking at the Colonoscopy example document (making changes in there)

    • Got to specimen requirements part of the document

 

Call Adjourned

 

12:04 PM EDT

 

Specimen CMT terms review

not discussed

 

 

FHIR conceptMap Follow Up

not discussed

Specimen CMT draft profile on ConceptMap:

 

Bring this to HL7 Terminology Infrastructre WG?

 

European Semantic work

not discussed

Link to the German FHIR IG around suceptibility testing:

ARS Implementation Guide (EN)

Semantic Example section: ARS Implementation Guide (EN)

 

Creating Value Sets for specimen related attributes

not discussed

  • Specimen reject reason table review - review the “unsatisfactory for evaluation due to …” concepts

 

Previous Action Items

not discussed

 

Specimen CMT - Hosting Options

not discussed

  • How can we publish the content in the dB?

  • SNOMED CT Extension and use of RefSets (start with VSAC value sets as proof of concept and then migrate over) to indicate:

    • preferred specimen types by domain

    • maybe also terms that need additional attributes (by kind of attribute) if we also write an implementation guide for it

  • How do we decide what format to share this in - get input from EHR-s and LIS vendors:

    • Write letter of mulitple stakeholders to request EHR-s and LIS vendors to implement

      • indicating that this is a patient safety issue, as incorrect Abx treatment will contribute to multi-drug resistance (use CTSI findings to provide background)

      • focus on blood, urine, wound cultures (get data from NHSN, too)

    • Nancy is talking to DHQP about the linkage with specimen collection

    • While we have HIT certification that is for the EHR-s there is currently no enforcement for implementation at the organizations

    • need C-suite buy-in

    • Professional organizations - like CAP and ACOS and AJCC get them to write the synoptic reports (better structuring of data) - for surgical aspects - similar to what CAP has done for Cancer (though they do not have the SCT codes included in the past - may be including SNOMED CT starting in 2025, but they are also using the SCT codes for observables) Synoptic reporting for cancer surgery: Current requirements and future state: The four CoC accreditation standards that include synoptic operative reporting requirements apply to sentinel lymph node biopsy for breast cancer (Standard 5.3), axillary lymph node dissection for breast cancer (Standard 5.4), wide local excision for primary cutaneous melanoma (Standard 5.5), and colonic resection for colon cancer (Standard 5.6). These accreditation standards were developed from the evidence-based recommendations for cancer surgery detailed in the Operative Standards for Cancer Surgery manuals.7,8

    • try to get AMA support to get providers to adopt this

    • Reach out to IDSA, too

 

Specimen CMT pilot implementers

not discussed

 

Specimen CMT - education

not discussed

  • Need education for providers and IT folks that helps with set up of the EHR-S / LIS configuration -this can be supported / accomplished? with the Implementaiton Guide we could write

  • if we have a use case of how a patient is impacted on their journey through the healthcare system - CAP created a nice video that showed how patient care was affected by incorrect data SHIELD FDA BAA Year 2

 

Specimen CMT - tracking implementation impact

  • Setting baseline

  • Define metrics

 not discussed

 

 

Specimen CMT - Compare to NHS Medical Terminology testing

 not discussed

 Will get updated vocab at a later date

 

Future projects for this call after CMT

not discussed

  • In general the call is intended as a forum for ANY messaging related issues to work out.

  • In the past we have

    • reviewed containers re-vive that - and how does that interact with devices (UDI identification?)

    • review code systems around additives (HL70371 and SCT substance and product hierarchies)

    • started work on cross-mapping between HL7 method codes and SNOMED CT procedure / technique concepts

      • American College of Surgeons is working on procedure protocol and synoptic data elements / surgical synoptic reports - we could work with them together on that

    • Look at other HL7 tables that we would want to migrate SCT (i.e., Specimen Condition table, etc.)

 

Recording:

Did not record

Chat:

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Action items

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